Video Tape Permission Form

In order to video tape my son, Calvin Harris, I must have permission from all parents of children that may come in contact with Calvin during video taping. Video taping occurs to teach parents of Calvin Harris and trained Aides how to better teach Calvin to interact with his peers.


Please sign the form below. If you have any questions about video taping, Calvin Harris, or autism, please call, email, or visit our website:

Kathy Harris
Home 541-766-8040
Work 541-737-9040
Keyharris@uswest.net

Tim Harris
Home 541-766-8040

Website:
http://www.users.uswest.net/~tbharris/


Calvin's team appreciates your interest and cooperation in helping,

Kathy Harris




I allow my child, _______________________________, to be video taped at Kindercare by Tim or Kathy Harris or Calley Fauth (therapist), or Robbin Sobotka-Soles (autism consultant). I understand that the video tape will be used in the strictest of confidence and only viewed by the aforementioned people and future new therapists for Calvin Harris. I understand that the even though the main point of video taping is to observe and critique Calvin Harris, my child may also be videotaped in the process.


Parent/legal guardian's Signature ____________________________________________

Date ___________________________________________________________________